I-864affidvit of Support

8/7/2019 I-864affidvit of Support

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I-864, Affidavit of Support

Under Section 213A of the Act

Form I-864 Instructions (Rev. 10/18/07)Y

Instructions

The following immigrants are required by law to submit Form

I-864 completed by the petitioner to obtain an immigrant visa

overseas or to adjust status to that of a lawful permanent

resident in the United States:

What Is the Purpose of This Form?

How Should I Complete This Form?

Department of Homeland SecurityU.S. Citizenship and Immigration Services

OMB No. 1615-0075; Expires 10/31/10

Print clearly or type your answers using CAPITAL letters.

Attach a separate sheet of paper (or more sheets if

necessary);

This form is required for most family-based immigrants and

some employment-based immigrants to show that they have

adequate means of financial support and that they are not

likely to become a public charge. For more information about

Form I-864, or to obtain related forms please contact:

How Is This Form Used?

This form is a contract between a sponsor and the U.S.

Government. Completing and signing this form makes you

the sponsor. You must show on this form that you have

enough income and/or assets to maintain the intending

immigrant(s) and the rest of your household at 125 percent of

the Federal Poverty Guidelines. By signing Form I-864, you

are agreeing to use your resources to support the intending

immigrant(s) named in this form, if it becomes necessary.

Who Needs This Form?

Are There Exceptions to

Who Needs This Form?

The following types of intending immigrants do not need to

file this form:

Use black or blue ink.

If you need extra space to answer any item:

--

Write your name, U.S. Social Security number and the

words "Form I-864" on the top right corner of thesheet;

and

--

Write the number and subject of each questionfor which

you are providing additional information.

--

The USCIS website (www.uscis.gov);

The National Customer Service Center (NCSC) telephone

line at 1-800-375-5283 TTY:(1-800-767-1833); or

Your local USCIS office by using Infopass.

The submission of this form may make the sponsored

immigrant ineligible for certain Federal, State, or local means-tested public benefits, because an agency that provides means-

tested public benefits will consideryourresources and assets

as available to the sponsored immigrant in determining his or

her eligibility for the program.

All family-based preference immigrants (unmarriedsons

and daughters of U.S. citizens, spouses and unmarried sons

and daughters of permanent resident aliens, married sons

and daughters of U.S. citizens, and brothers and sisters of

U.S. citizens age 21 and older); and

All immediate relatives of U.S. citizens (spouses, unmarried

children under age 21, and parents of U.S. citizensage 21

and older);

Employment-based preference immigrants in cases only

when a U.S. citizen or lawful permanentresident relative

filed the immigrant visa petition or such relative has a

significant ownership interest (fivepercent or more) in the

entity that filed the petition.

Any intending immigrant who has earned or can be credited

with 40 qualifying quarters (credits) of work in the United

States. In addition to their own work, intending immigrants

may be able to secure credit for work performed by a

spouse during marriage and by their parent(s) while the

immigrants were under 18 years of age. The Social Security

Administration (SSA) can provide information on how to

count quarters of work earned or credited and how to

provide evidence of such. See the SSA website atwww.ssa.gov/mystatement/credits for more information;

Not all benefits are considered to be means-tested public

benefits. See Form I-864P, Poverty Guidelines, for more

information on which benefits may be covered by this

definition, or the contract on Page 6 of this form for a list ofbenefits explicitly not considered means-tested public

benefits.

If the immigrant sponsored in this affidavit does receive one

of the designated Federal, State or local means-tested public

benefits, the agency providing the benefit may request that

you repay the cost of those benefits. That agency can sue you

if the cost of the benefits provided is not repaid.

Any intending immigrant who will, upon admission, acquire

U.S. citizenship under section 320 of the Immigration and

Nationality Act, as amended by the Child Citizenship Act of

2000 (CCA);

Self-petitioning widow/ers who have an approved Petition

for Amerasian, Widow(er), or Special Immigrant, Form

I-360; and


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Form I-864 Instructions (Rev. 10/18/07)Y Page

Self-petitioning battered spouses and children who have an

approved Petition for Amerasian, Widow(er), or Special

Immigrant, Form I-360.

NOTE: If you qualify for one of the exemptions listed above,

submit Form I-864W, Intending Immigrant's I-864 Exemption,

instead of Form I-864.

If you are on active duty in the U.S. Armed Forces, including

the Army, Navy, Air Force, Marines or Coast Guard, and you

are sponsoring your spouse or minor child, you only need to

have an income of 100 percent of the Federal poverty line for

your household size. This provision does not apply to joint or

substitute sponsors.

A sponsor completes and signs Form I-864. A sponsor is

required to be at least 18 years old and domiciled in the

United States, or its territories or possessions (see Step-by-

step Instructions for more information on domicile). The

petitioning sponsor must sign and complete Form I-864, even

if a joint sponsor also submits an I-864 to meet the income

requirement. The list below identifies who must become

sponsors by completing and signing a Form I-864.

Who Completes and Signs Form I-864?

The U.S. citizen or lawful permanent resident who filed a

Form I-130 for a family member, Form I-129F for a

fiance(e), or Form I-600 or I-600A foran orphan.

The U.S. citizen or permanent resident alien who filed an

employment-based immigrant visa petition (Form I-140) for

a spouse, parent, son, daughter, orsibling who:(1) has asignificant ownership interest (five percent ormore) in the

business which filed the employment-based immigrant visa

petition; or (2)is related to the intending immigrant as a

spouse, parent, son, daughter, or sibling.

To qualify as a sponsor, you must demonstrate that your

income is at least 125 percent of the current Federal poverty

guideline for your household size. The Federal poverty line,

for purposes of this form, is updated annually and can be

found on Form I-864P, Poverty Guidelines.

What Are the Income Requirements?

If your income alone is not sufficient to meet the requirement

for your household size, the intending immigrant will be

ineligible for an immigrant visa or adjustment of status, unless

the requirement can be met using any combination of the

following:

What If I Cannot Meetthe Income Requirements?

Income from the intending immigrant, if that income will

continue from the same source afterimmigration, and if the

intending immigrant iscurrently living in your residence. If

the intendingimmigrant is your spouse, his or her income

can be counted regardless of current residence, but it must

continue from the same source after he or she becomes a

lawful permanent resident.

Income from any relatives or dependents living inyour

household or dependents listed on your mostrecent Federal

tax return who signed a Form I-864A;

A joint sponsor whose income and/or assets equal at least

125 percent of the Poverty Guidelines. See question below

for more information on joint sponsors.

The value of your assets, the assets of any householdmember who has signed a Form I-864A,or the assets of the

intending immigrant;

You may use the income of your spouse and/or any other

relatives living in your residence if they are willing to be

jointly responsible with you for the intending immigrant(s)

you are sponsoring. If you have any unrelated dependents

listed on your income tax return you may include their income

regardless of where they reside.

How Can My Relatives and DependentsHelp Me Meet the Income Requirements?

Your household size includes yourself and the following

individuals, no matter where they live: any spouse, anydependent children under the age of 21, any other dependents

listed on your most recent Federal income tax return, all

persons being sponsored in this affidavit of support, and any

immigrants previously sponsored with a Form I-864 or Form

I-864 EZ affidavit of support whom you are still obligated to

support. If necessary to meet the income requirements to be a

sponsor, you may include additional relatives (adult children,

parents, or siblings) as part of your household size as long as

they have the same principle residence as you and promise to

use their income and resources in support of the intending

immigrant(s).

How Do I Count Household Size?

The income of such household members and dependents can

be used to help you meet the income requirements if they

complete and sign Form I-864A, Contract Between Sponsor

and Household Member, and if they are at least 18 years of

age when they sign the form.

Can the Intending Immigrant HelpMe Meet the Income Requirements?

If certain conditions are met, the intending immigrant's

income can help you meet the income requirement. If theintending immigrant is your spouse, his or her income can be

included if it will continue from the same source after he or

she obtains lawful permanent resident status. If the intending

immigrant is another relative, there are two requirements.

First, the income must be continuing from the same source

after he or she obtains lawful permanent resident status, and

second, the intending immigrant must currently live with you

in your residence. Evidence must be provided to support both

requirements.


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However, an intending immigrant whose income is being used

to meet the income requirement does not need to complete

Form I-864A, Contract Between Sponsor and Household

Member, unless the intending immigrant has a spouse and/or

children immigrating with him or her. In this instance, the

contract relates to support for the spouse and/or children.

Does Receipt of Means-Tested Public Benefits

Disqualify me From being a Sponsor?

Assets may supplement income if the consular or immigration

officer is convinced that the monetary value of the asset could

reasonably be made available to support the sponsored

immigrant and converted to cash within one year without

undue harm to the sponsor or his or her family members. Youmay not include an automobile unless you show that you own

at least one working automobile that you have not included.

How Can I Use Assets to Qualify?

No. Receipt of means-tested public benefits does not

disqualify anyone from being a sponsor. However, means-

tested public benefits cannot be accepted as income for the

purposes of meeting the income requirement.

If the first joint sponsor completes Form I-864 for some rather

than all the family members, a second qualifying joint sponsor

will be required to sponsor the remaining family members.

There may be no more than two joint sponsors. A joint

sponsor must be able to meet the income requirements for all

the persons he or she is sponsoring without combining

resources with the petitioning sponsor or a second joint

sponsor. Any dependents applying for an immigrant visa or

adjustment of status more than six months after immigration of

the intending immigrants must be sponsored by the petitioner

but may be sponsored by an original joint sponsor or a different

joint sponsor.

Even if one or more I-864s are submitted for an intending

immigrant, the petitioning sponsor remains legallyaccountable for the financial support of the sponsored alien

along with the joint sponsor(s).

If the person who is seeking the immigration of one or more

of his or her relatives cannot meet the income requirements, a

"joint sponsor" who can meet the requirements may submit a

Form I-864 to sponsor all or some of the family members.

A joint sponsor can be any U.S. citizen, U.S. national, or

lawful permanent resident who is at least 18 years old,

domiciled in the United States, or its territories or possessions,and willing to be held jointly liable with the petitioner for the

support of the intending immigrant. A joint sponsor does not

have to be related to the petitioning sponsor or the intending

immigrant.

A substitute sponsor is a sponsor who is completing a

Form I-864 on behalf of an intending immigrant whose

original I-130 petitioner has died after the Form I-130 was

approved, but before the intending immigrant obtained

permanent residence.

The substitute sponsor must be related to the intendingimmigrant in one of the following ways: spouse, parent,

mother-in-law, father-in-law, sibling, child (at least 18 years o

age), son, daughter, son-in-law, daughter-in-law, brother-in-

law, sister-in-law, grandparent, grandchild or legal guardian.

The substitute sponsor must also be a U.S. citizen or lawful

permanent resident.

If you are a substitute sponsor, you must indicate that that you

are related to the intending immigrant in one of the ways

listed above and include evidence proving that relationship.

The beneficiary must also file this form along with a written

statement explaining the reasons why the Form I-130 visa

petition should be reinstated, having been revoked followingthe petitioner's death. The beneficiary must also include a

copy of the Form I-130 approval notice.

What Is a Substitute Sponsor?

What Is a Joint Sponsor?

Your obligation to support the immigrant(s) you are

sponsoring in this affidavit of support will continue until the

sponsored immigrant becomes a U.S. citizen, or can be

credited with 40 qualifying quarters of work in the United

States.

Although 40 qualifying quarters of work (credits) generally

equate to ten years of work, in certain cases the work of a

spouse or parent adds qualifying quarters. The Social Security

Administration can provide information on how to count

qualifying quarters (credits) of work.

The obligation also ends if you or the sponsored immigrant

dies or if the sponsored immigrant ceases to be a lawful

permanent resident and departs the United States. Divorce

does not end the sponsorship obligation.

How Long Does My Obligationas a Sponsor Continue?

You must submit a Form I-864 affidavit of support for each

intending immigrant you are sponsoring. You may submit

photocopies if you are sponsoring more than one intending

immigrant listed on the same affidavit of support.

Separate affidavits of support are required for intending

immigrants for whom different Form I-130 family-based

petitions were filed. For instance, if you are sponsoring both

parents, each will need an original affidavit of support and

accompanying documentation since you were required to

submit separate Form I-130 visa petitions for each parent.

Do I Need to Submit a Separate

Affidavit for Each Family Member?


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Form I-864 Instructions (Rev. 10/18/07)YPage 4

Often a spouse or minor children obtain visas or adjust status

as dependents of a relative, based on the same visa petition. If

you are sponsoring such dependents, you only need to provide

a photocopy of the original Form I-864, as long as these

dependents are immigrating at the same time as the principal

immigrant or within six months of the time he or she

immigrates to the United States. You do not need to provide

copies of the supporting documents for each of the

photocopied Forms I-864.

If the intending immigrant will apply for an immigrantvisa at a U.S. Embassy or Consulate overseas:

Complete Form I-864 when it is mailed to you from the

National Visa Center (NVC). Different instructions apply to

some cases so follow the instructions provided by the National

Visa Center for your particular case. The instructions on when

and where to submit Form I-864 are included in the

information packet that is mailed to you with Form I-864.

Form I-864 and all accompanying documentation must be

submitted to the government within one year of when you sign

Form I-864.

When Do I Complete Form I-864and Where Do I Send It?

Federal law requires that every sponsor report every change of

address to the USCIS within 30 days of the change. To do

this, send a completed Form I-865, Sponsor's Change of

Address, to the Service Center having jurisdiction over your

new address.

Do not complete Form I-865 at the same time that youcomplete the I-864.

If the intending immigrant will adjust status in the UnitedStates:

Complete FormI-864 when the intending immigrant is readyto submit his or her Form Application to Register Permanent

Residence or Adjust Status. Then give the completed Form

I-864 along with any Forms I-864A and all supporting

documentation to the intending immigrant to submit with hisor her application for adjustment of status. To be valid, Form

I-864 and all supporting documentation must be submitted

within one year of when you sign Form I-864. For privacy,

you may enclose these documents in a sealed envelope

marked "Form I-864: To Be Opened Only by a U.S.

Government Official." You may be requested to submit

updated information if there is a significant delay in

processing.

Do I Have to Report MyChange of Address If I Move?

You should complete and submit Form I-865 to USCIS only

when the address you indicated on the original I-864 Affidavit

of Support has changed. Please see Form I-865 for further

directions on filing the Sponsor's Change of Address. This

requirement does not relieve a sponsor who is a lawful

permanent resident from submitting Form AR-11 within ten

days of a change of address.


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Step-by-Step InstructionsForm I-864 is divided into nine parts. The information below will help you fill out the form.

Checkbox "f" if you are the substitute sponsor. A substitute

sponsor is a sponsor who is completing a Form I-864 onbehalf of an intending immigrant whose original Form I-130

petitioner has died after the Form I-130 was approved, but

before the intending immigrant obtained permanent

residence. The substitute sponsor must be related to the

intending immigrant in one of the following ways: spouse,

parent, mother-in-law, father-in-law, sibling, child (at least 18

years of age), son, daughter, son-in-law, daughter-in-law,

brother-in-law, sister-in-law, grandparent, grandchild or legal

guardian. The substitute sponsor must also be a U.S. citizen

or lawful permanent resident. If you are a substitute sponsor,

you must sponsor each intending immigrant.

Checkbox "a" if you are the petitioner who is filing or whohas already filed Form I-130, Petition for Alien Relative;

Form I-600, Petition to Classify Orphan as an Immediate

Relative; or Form I-600A, Application for Advance

Processing of Orphan Petition. If you are the petitioner, you

must sponsor each intending immigrant.

Part 1. Basis for Filing Affidavit of Support.

Checkbox "d" if you are the only joint sponsor or box "e" ifyou are either of two joint sponsors. A joint sponsor must be a

person, and may not be a corporation, organization, or other

entity. A joint sponsor does not have to be related to the

intending immigrant. Indicate whether you are the only joint

sponsor or one of two joint sponsors. Check with the

petitioning sponsor or the intending immigrant if you are not

certain.

Checkbox "b" if you are filing or have filed Form I-140,Immigrant Petition for Alien Worker, for your husband, wife,

father, mother, child, adult son or daughter, brother, or sister.

Checkbox "c" if you have an ownership interest of at least

five percent in a business, corporation or other entity that filed

or is filing a Form I-140 for your husband, wife, father,mother, child, adult son or daughter, brother, or sister.

6. Alien Registration Number. An "A-number" is an AlienRegistration Number assigned by the former Immigration and

Naturalization Service (INS) or U.S. Citizenship and

Immigration Services (USCIS). If the intending immigrants

you are sponsoring have not previously been in the United

States or have only been in the United States as tourists, they

probably do not have A-numbers. Persons with A-numbers

can locate the number on their INS or USCIS-issued

documentation.

Part 2. Information on the Principal Immigrant.The principal immigrant is the intending immigrant whois the primary beneficiary of the visa petition.

8. Indicate whether you are sponsoring the principalimmigrant listed in item 2 in this Form I-864. This only

applies to cases with two joint sponsors. Check "No" only ifyou are sponsoring only intended immigrants listed in 9 (a

through e) and not the principal immigrant listed in item 2.

15.Country of Domicile. This question is asking you toindicate the country where you maintain your principal

residence and where you plan to reside for the foreseeable

future. If your mailing address and/or place of residence is

not in the United States, but your country of domicile is theUnited States, you must attach a written explanation and

documentary evidence indicating how you meet the domicile

requirement. If you are not currently living in the United

States, you may meet the domicile requirement if you can

submit evidence to establish that any of the following

conditions apply:

9. Accompanying Family Members You are Sponsoring.The immigrant you are sponsoring may be bringing a spouse

and/or children to the United States. If the spouse and/or

children will be traveling with the immigrant, or within six

months of the immigrant's entry to the United States and you

are sponsoring them, you should list the names and other

requested information on the lines provided. If anydependents are not immigrating, will be immigrating more

than 6 months after the sponsored alien arrives in the United

States, or you are not sponsoring them, do not list their names

here. A separate Form I-864 will be required for them when

they apply for their immigrant visas.

Part 4. Information on the Sponsor.

Part 3. Information on Immigrants

You Are Sponsoring.


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Form I-864 Instructions (Rev. 10/18/07)YPage 6

A public international organization in which the United

States participates by treaty or statute;

A U.S. firm or corporation engaged in whole or in part in

the development of foreign trade and commerce with the

United States, or a subsidiary ofsuch a firm or corporation;

--

--

B. You are living abroad temporarily.

If you are not currently living in the United States, you must

show that your trip abroad is temporary and that you have

maintained your domicile in the United States. You can show

this by providing proof of your voting record in the United

States, proof of paying U.S. State or local taxes, proof of

having property in the United States, proof of maintaining

bank or investment accounts in the United States, or proof of

having a permanent mailing address in the United States.

Other proof could be evidence that you are a student studying

abroad or that a foreign government has authorized a

temporary stay.

C. You intend in good faith to reestablish your domicile inthe United States no later than the date of the intending

immigrant's admission or adjustment of status.

You must submit proof that you have taken concrete steps to

establish you will be domiciled in the United States at a time

no later than the date of the intending immigrant's admission

or adjustment of status. Concrete steps might include

accepting a job in the United States, signing a lease or

purchasing a residence in the United States, or registering

children in U.S. schools. Please attach proof of the steps you

have taken to establish domicile as described above.

Proof of U.S. citizen, national, or permanent resident status isrequired for joint and substitute sponsors and for relatives of

employment-based immigrants who file this form. Petitioning

relatives who have already filed proof of their citizenship or

immigration status with Forms I-130, Form I-129F, I-600 and

I-600A do not need to submit proof of their status with this

form.

19. Citizenship/Residency.

A religious denomination having a bona fide organization in

the United States, if the employment abroad involves theperson's performance of priestly or ministerial functions on

behalf of the denomination; or

--

A religious denomination or interdenominational

missionary organization having a bona fide organization in

the United States, if the person is engaged solely as a

missionary.

--

18. U.S. Social Security Number.

Every sponsor's Social Security number is required by law. If

you do not currently have a Social Security number you must

obtain one before submitting this Form I-864.

Proof of permanent resident status includes a photocopy ofboth sides of the "green card,"Form I-551, Alien RegistrationReceipt Card/Permanent Resident Card; or a photocopy of an

unexpired temporary I-551 stamp in either a foreign passport

or a DHS Form I-94, Arrival/Departure Document.

Proof of U.S. citizen or national status includes a copy of your

birth certificate, certificate of naturalization, certificate of

citizenship, consular report of birth abroad to citizen parents,

or a copy of the biographic data page of your U.S. passport.

Check "yes" if you are the petitioning sponsor and on active

duty in the U.S. Army, Navy, Air Force, Marines,or Coast

Guard, other than for training. If you provide evidence that

you are currently on active duty in the military and you are

petitioning for your spouse or minor child, you will need todemonstrate income at only 100 percent of the poverty level

for your household size, instead of at 125 percent of the

poverty level. (See Form I-864P for information on the

poverty levels.) Check "no" if you are not on active duty in

the U.S. military. This provision does not apply to joint and

substitute sponsors.

20. Military Service.

This section asks you to add together the number of persons

for whom you are financially responsible.Some of these

persons may not be residing with you. Make sure you do notcount any individual more than once, since in some cases the

same person could fit into two categories. For example, your

spouse (whom you would enter on line 21c) might also be alawful permanent resident whom you have already sponsored

using Form I-864 (line 21f). If you included your spouse online 21c, do not include him or her again on line 21f.

Part 5. Sponsor's Household Size.

A. You are employed by a certain organization.

Some individuals employed overseas are automatically

considered to be domiciled in the United States because of the

nature of their employment. The qualifying types of

employment include employment by:

An American institution of research recognized bythe

Secretary of Homeland Security (The list of

qualifyinginstitutions may be found at 8 CFR 316.20);

--

The U.S. government;--


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Form I-864 Instructions (Rev. 10/18/07)Y Page 7

21f- Enter the number of lawful permanent residents whom

you are currently obligated to support based on your previous

submission of Form I-864 as a petitioning, substitute, or joint

sponsor, or of Form I-864EZ as a petitioning sponsor. Include

only those persons who have already immigrated to the United

States. Do not include anyone for whom your obligation to

support has ended through the sponsored immigrant'sacquisition of U.S. citizenship, death, abandonment of lawful

permanent residence in the United States, acquisition of 40

quarters of earned or credited work in the United States, or

obtaining a new grant of adjustment of status while in removal

proceedings based on a new affidavit of support, if one is

required.

21d - Enter the number of unmarried children you have whoare under age 21, even if you do not have legal custody of

these children. You may exclude any unmarried children

under 21, if these children have reached majority under the

law of their place of domicile and you do not claim them as

dependents on your income tax returns.

21e - Enter the number of any other dependents. You must

include each and every person whom you have claimed as adependent on your most recent Federal income tax return,

even if that person is not related to you. Even if you are not

legally obligatedto support that person, you must include the

person if in fact you did support that person and claimed the

person as a dependent.

21g - This question gives you the option of including certain

other non-dependent relatives who are living in your residence

as part of your household size. Such relatives may include

your mother, father, sister, brother or adult children, if they are

living in your residence. However, the only reason to include

these family members in your household size is if you need toinclude their income when you calculate your household

income for purposes of meeting the income requirement for

this form. To be considered, any relative indicated in this

category must sign and submit Form I-864A.

Part 6. Sponsor's Income and Employment.

Check the box (a through d) that applies to you.

22. Job Classification.

This section is used to determine the sponsor's household

income. Take your annual individual income from line 23 and

enter it on line 24a. If this amount is greater than 125 percent(or 100 percent if you are on active duty in the U.S. military

and sponsoring your spouse or child) of the Federal PovertyGuidelines for your household size from line 21h, you do not

need to include any household member's income. See Form

I-864P for reference on the Poverty Guidelines.

24. Annual Household Income.

If you included the income of your spouse listedin 21c, orany child listed in 21d, or any dependent listed in 21e, or

any other relative listed in 21g, each one of theseindividuals must be over 18 years of age and must complete

Form I-864A.

To determine the filing requirements for your relatives

included in item 24b, follow these instructions:

If you included the income of the intendingimmigrant who

is your spouse (he or she would becounted on line 21a),

evidence that his/her incomewill continue from the current

source after obtaining lawful permanent resident status must

beprovided. He/she does not need to complete Form

I-864A unless he/she has accompanying children.

If you included the income of the intending immigrant who

is not your spouse, (he or she wouldbe counted on line

21a), evidence that his or her income will continue from thecurrent source after obtaining lawful permanent resident

status must beprovided and the intending immigrantmustprovide evidence that he/she is living in your

residence. He or she does not need to complete

FormI-864A, Contract Between Sponsor and Household

Member, unless he or she has an accompanying spouse or

children.

You may include evidence supporting your claim about your

expected income for the current year if you believe that

submitting this evidence will help you establish ability to

maintain sufficient income. You are not required to submit

this evidence, however, unless specifically instructed to doso by a Government official. For example, you may includea recent letter from your employer, showing your employer's

address and telephone number, and indicating your annual

salary. You may also provide pay stub(s) showing yourincome for the previous six months. If your claimed income

includes alimony, child support, dividend or interest income,

or income from any other source, you may also include

evidence of that income.

Enter your current individual earned or retirement annual

income that you are using to meet the requirements of this

form and indicate the total on this line.

23. Current Individual Annual Income.


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If you provide a photocopy of your tax return(s), you must

include a copy of each and every FormW-2 and Form 1099

that relates to your return(s). Do not include copies of these

Forms if you provide an IRS transcript of your return(s) rather

than a photocopy.

You must provide either an IRS transcript or a photocopy

from your own records of your Federal individual income tax

return for the most recent tax year. If you believe additional

returns may help you to establish your ability to maintain

sufficient income, you may submit transcripts or photocopies

of your Federal individual income tax returns for the threemost recent years.

25. Federal Income Tax Information.

Do not submit copies of your State income tax returns. Donot submit any tax returns that you filed with any foreigngovernment unless you claim that you were not required to

file a Federal tax return with the United States government

and you wish to rely on the foreign return solely to establishthe amount of your income that is not subject to tax in the

United States.

If you checked box 22(b) (self-employed), you should havecompleted one of the following forms with your Federal

income tax return: Schedule C (Profit or Loss from Business),

Schedule D (Capital Gains), Schedule E (SupplementalIncome or Loss) or Schedule F (Profit or Loss from Farming).

You must include each and every Form 1040 Schedule, if any,

that you filed with your Federal tax return.

If you were required to file a Federal income tax return during

any of the previous three tax years but did not do so, you must

file any and all late returns with IRS and attach an IRS-

generated tax return transcript documenting your late filing

before submitting the I-864 Affidavit of Support. If you were

not required to file a Federal income tax return under U.S. tax

law because your income was too low, attach a written

explanation. If you were not required to file a Federal income

tax return under U.S. tax law for any other reason, attach awritten explanation including evidence of the exemption and

how you are subject to it. Residence outside of the United

States does not exempt U.S. citizens or lawful permanent

Only complete this Part if you need to use the value of assets

to meet the income requirements. If your Total HouseholdIncome (indicated on Line 24c) is equal to or more thanneeded to meet the income requirement as shown by the

current Poverty Guidelines (Form I-864P) for your household

size (indicated on Line 21h), you do not need to complete thisPart. If your total household income does not meet the

requirement, you may submit evidence of the value of your

assets, the sponsored immigrant's assets, and/or assets of a

household member that can be used, if necessary, for the

support of the intending immigrant(s). The value of assets of

all of these persons may be combined in order to meet the

necessary requirement.

For purposes of this affidavit, the line for gross (total) income

on IRS Forms 1040 and 1040A will be considered when

determining income. For persons filing IRS Form 1040 EZ,

the line for adjusted gross income will be considered.

Part 7. Use of Assets to Supplement Income.

You may include the net value of your home as an asset. The

net value of the home is the appraised value of the home,

minus the sum of any and all loans secured by a mortgage,

trust deed, or other lien on the home. If you wish to include

the net value of your home, this, you must include

documentation demonstrating that you own it, a recent

appraisal by a licensed appraiser, and evidence of the amount

of any and all loans secured by a mortgage, trust deed, or

other lien on the home. You may not include the net value an

automobile unless you show that you have more than one

automobile, and at least one automobile is not included as an

asset.

Only assets that can be converted into cash within one yearand without considerable hardship or financial loss to the

owner may be included. The owner of the asset must include

a description of the asset, proof of ownership, and the basis

for the owner's claim of its net cash value.

You are not required to have the IRS certify the transcript or

photocopy unless specifically instructed to do so by a

Government official; a plain transcript or photocopy is

acceptable. Telefile tax records are not acceptable proof of

filing.

Obtaining Tax Transcripts.You may use Internal Revenue

Service (IRS) Form 4506-T to request tax transcripts from the

IRS. Complete IRS Form 4506-T with the ending date for

each of your three most recent tax years listed on line 9.

Follow all instructions for completing and filing Form 4506-T

with the IRS.

residents from filing a U.S. Federal income tax return. See

"Filing Requirements" in the IRS Form 1040 Filing

Instructions to determine whether you were required to file.


9/19


In order to qualify based on the value of your assets, the total

value of your assets must equal at least five times the

difference between your total household income and the

current poverty guidelines for your household size. However,

if you are a U.S. citizen and you are sponsoring your spouse

or minor child, the total value of your assets must only be

equal to at least three times the difference. If the intending

immigrant is an alien orphan who will be adopted in theUnited States after the alien orphan acquires permanent

residence, and who will, as a result, acquire citizenship under

section 320 of the Act, the total value of your assets need only

equal the difference.

To use the assets of a relative (spouse, adult son or daughter,

parent or sibling), the relative must reside with you and have

completed a Form I-864A, Contract Between Sponsor and

Household Member, with accompanying evidence of assets.

The Form I-864A and accompanying evidence of assets is

submitted with Form I-864. You may use the assets of more

than one relative who resides with you so long as you submit a

complete Form I-864A with evidence of assets for each such

relative.

27. Household Member's Assets.

You may use the assets of the intending immigrant regardless

of where he or she resides. The intending immigrant mustprovide evidence of such assets with this form. Form I-864A

is not required to document the intending immigrant's assets.

28. Assets of the Intending Immigrant.

29. Total Value of Assets.

Example of How to Use Assets: If you are petitioning for aparent and the poverty line for your household size is $22,062

and your current income is $18,062, the difference between

your current income and the poverty line is $4,000. In order

for assets to help you qualify, the combination of your assets,

plus the assets of any household member who is signing Form

I-864A, plus any available assets of the sponsored immigant,

would have to equal five times this difference (5 x $4,000). Inthis case, you would meet the income requirements if the net

value of the assets equaled at least $20,000.

The Government may pursue verification of any information

provided on or in support of this form, including employment,

income, or assets with the employer, financial or other

institutions, the Internal Revenue Service, or the Social Securi

Administration. If you include in this affidavit of support any

information that you know to be false, you may be liable for

criminal prosecution under the laws of the United States.

Penalties.

Read the contract carefully, print your name, and then sign

and date the form. If you do not print your name on line 30

and sign and date the form on line 31, the intendingimmigrant you are sponsoring cannot be issued a visa or

be granted adjustment of status.

Part 8. Sponsor's Contact.

To use your own assets, you must complete lines 26a through

26d and submit corresponding evidence with this form.

Supporting evidence must be attached to establish location,

ownership, date of acquisition, and value of any real estate

holding.

26. Assets.

If you fail to give notice of your change of address, as

required by 8 U.S.C. 1183a(d) and 8 CFR 213a.3, you may be

liable for the civil penalty established by8 U.S.C. 1183a(d)

(2). The amount of the civil penalty will depend on whether

you failed to give this notice because you were aware that the

immigrant(s) you sponsored had received Federal, State, or

local means-tested public benefits.

If the failure to report your change of address occurs with

knowledge that the sponsored immigrant received means-

tested public benefits (other than benefits described in section

401(b), 403(c)(2), or 4ll(b) of the Personal Responsibility and

Work Opportunity Reconciliation Act of 1996, which are

summarized in the contract in Part 8) such failure may result

in a fine of not less than $2,000 or more than $5,000.

Otherwise, the failure to report your change of address may

result in a fine not less than $250 or more than $2,000.

Authority for the collection of the information requested on

this form is contained in 8 U.S.C. 1182a(4), 1183a, 1184(a),

and 1258. The information will be used principally by an

immigration judge, USCIS or a Consular Officer to support an

alien's application for benefits under the Immigration and

Nationality Act and specifically the assertion that he or she has

adequate means of financial support and will not become a

public charge. Submission of the information is voluntary.Failure to provide the information will result in denial of the

application for an immigrant visa or adjustment of status.

Privacy Act Notice.

Other Information.


10/19


A person is not required to respond to a collection of

information unless it displays a currently valid OMB control

number.

We try to create forms and instructions that are accurate, can be

easily understood, and which impose the least burden on you to

provide us with information. Often this is difficult because

some immigration laws are very complex.

The estimated average time to complete and file this form is as

follows: (1) 75 minutes to learn about the law and form; (2) 90

minutes to complete the form; and (3) 3 hour and 15 minutes to

assemble and file the form; for a total estimated average of 6hours per form.

If you have comments regarding the accuracy of this estimate,

or suggestions for making this form simpler, write to U.S.

Citizenship and Immigration Services, Regulatory Management

Division, Attn: OMB No. 1615-0075, 111 Massachusetts

Avenue N.W., Washington, D.C. 20529.Do not mail your

completed affidavit of support to this address.

Reporting Burden.

The information may also, as a matter of routine use, be

disclosed to other Federal, State and local agencies providing

means-tested public benefits for use in civil action against the

sponsor for breach of contract. Social Security numbers may

be verified with the Social Security Administration consistant

with the consent signed as part of the contract in Part 8 of theForm I-864. It may also be disclosed as a matter of routine use

to other Federal, State, local, and foreign law enforcement and

regulatory agencies to enable these entities to carry out theirlaw enforcement responsibilities.

To order USCIS forms, call our toll-free forms line at

1-800-870-3676. You can also obtain forms and informationon immigration laws, regulations and procedures by

telephoning our National Customer Service Center at

1-800-375-5283 or visiting our internet website at

www.uscis.gov.

USCIS Forms and Information.

Use InfoPass for Appointments.

As an alternative to waiting in line for assistance at your local

USCIS office, you can now schedule an appointment through

our internet-based system, InfoPass. To access the system,visit our website at www.uscis.gov. Use the InfoPassappointment scheduler and follow the screen prompts to set up

your appointment. InfoPass generates an electronicappointment notice that appears on the screen. Print the notice

and take it with you to your appointment. The notice gives the

time and date of your appointment, along with the address of

the USCIS office.


11/19

If you use your assets or the assets of a household member to qualify,

If you are a joint sponsor, substitute sponsor, or the relative of an employment-based immigrant requiring an affidavit

of support, proof of your citizenship status, U.S. national status or lawful permanent resident status.

A separate Form I-864A for each household member using assets other than for the intending immigrant.

Documentation of assets establishing location, ownership, date of acquisition and value. Evidence of any

liens or liabilities against these assets.

Check List

For U.S. citizens or nationals, a copy of your birth certificate, passport, or certificate of naturalization or

citizenship.


The following items must be submitted with Form I-864:

For ALL sponsors:

If you are currently self-employed, a copy of your Schedule C, D, E or F from your most recent Federal Tax Returnwhich establishes your income from your business.

For SOME sponsors:

A copy of your individual Federal income tax return, including W-2s for the most recent tax year, or a statement

and/or evidence describing why you were not required to file. Also include a copy of each and every Form 1099,

Schedule, and any other evidence of reported income. You may submit this information for the most recent three tax

years , pay stub(s) from the most recent six months, and/or a letter from your employer if you believe any of theseitems will help you qualify.

___

___

If you are sponsoring more than one intending immigrant listed on the same affidavit of support, photocopies of the

original affidavit of support may be submitted for any additional intending immigrants listed. Copies of supporting

documentation are not required for these family members.

___

If you are the petitioning sponsor and on active duty in the U.S. Armed Forces and are sponsoring your spouse orchild using 100 percentof governing poverty guideline, proof of your active military status.

___

If you are using the income of persons in your household or dependents to qualify,___

A separate Form I-864A for each person whose income you will use. However, an intending immigrantwhose income is being used needs to complete Form I-864A only if his or her spouse and/or children are

immigrating with him or her.

___

Proof of their residency in your household and relationship to you if they are not the intendingimmigrantsor are not listed as dependents on your Federal income tax return for the most recent tax year.

___

Proof that the intending immigrant's current employment will continue from the same source if his orherincome is being used.

___

A copy of their individual Federal income tax return, including W-2s and 1099s, for the most recent taxyear, or evidence that they were not required to file. You may submit this information for the most recent

three years if you believe it will help you qualify.

___

___

___

___

___

___

For lawful permanent residents, a copy of both sides of your Form I-551, Permanent Resident Card.___


12/19

For GovernmentUse Only

which filed an alien worker petition on behalf of the intending immigrant, who is related tome as my

I-864, Affidavit of Suppor

Under Section 213A of the Ac

Location

Date (mm/dd/yyyy)

1. I,

Part 2. Information on the principal immigrant.

3. Mailing Address Street Number and Name (Include Apartment Number)

This I-864 is from:

Reviewer

Number of Affidavits of

Support in file:

Form I-864 (Rev. 10/18/07)

does not meet the

requirements of

section 213A.

meets therequirements of

section 213A.

This I-864:

the Petitioner

a Joint Sponsor #

______________

the Substitute

Sponsor

Department of Homeland SecurityU.S. Citizenship and Immigration Services

5% Owner

First Name

OMB No. 1615-0075; Expires 10/31/1

Part 1. Basis for filing Affidavit of Support.

Middle Name

2. Last Name

City State/Province Zip/Postal Code Country

4. Country of Citizenship 5. Date of Birth (mm/dd/yyyy)

6. Alien Registration Number (if any)

A-

7. U.S.Social Security Number (if any)

Part 3. Information on the immigrant(s) you are sponsoring.

8.

b.

c.

d.

a.

U.S.Social Security

Number (if any)

Date of Birth

(mm/dd/yyyy) A-Number (if any)NameRelationship to

Sponsored Immigrant

e.

10. Enter the total number of immigrants you are sponsoring on this form from Part 3, Items 8 and 9.

I am sponsoring the principal immigrant named in Part 2 above.

9. I am sponsoring the following family members immigrating at the same time or within six months of the principalimmigrant named in Part 2 above. Do not include any relative listed on a separate visa petition.

Yes No (Applicable only in cases with two joint sponsors)

1 2

I am the only joint sponsor.

a. I am the petitioner. I filed or am filing for the immigration of my relative.

I filed an alien worker petition on behalf of the intending immigrant, who is related to me asmy

b.

I have an ownership interest of at least 5 percent inc.

d.

I am thee.

The original petitioner is deceased. I am the substitute sponsor. I am the intending

immigrant'sf.

am the sponsor submitting this affidavit of support because (Check only one box):

,

,

.

first second of two joint sponsors. (Check appropriate box.)


13/19

I am a lawful permanent resident. My alien registration number is A-

Part 4. Information on the Sponsor.

Middle Name

Form I-864 (Rev. 10/18/07)Y Page 2

Last Name

First Name

11. Name

16. Date of Birth (mm/dd/yyyy)

City

Street Number and Name (Include Apartment Number)

Country

13. Place of Residence

(if different from

mailing address)

14. Telephone Number (Include Area Code or Country and City Codes)

15. Country of Domicile

19. Citizenship/Residency

If you checked box (b), (c), (d), (e) or (f) in line 1 on Page 1, you must include proof of your

citizen, national, or permanent resident status.

Zip/Postal Code

State or Province

20. Military Service (To be completed by petitioner sponsors only.)

12. Mailing Address

Street Number and Name (Include Apartment Number)

City State or Province

Zip/Postal CodeCountry

17. Place of Birth (City) CountryState or Province

I am currently on active duty in the U.S. armed services.

For Government

Use Only

18. U.S. Social Security Number (Required)

I am a U.S. citizen.

I am a U.S. national (for joint sponsors only).

NoYes


14/19

(Date)

21. Your Household Size - DO NOT COUNT ANYONE TWICE

Part 5. Sponsor's household size.

Persons you are sponsoring in this affidavit:

a. Enter the number you entered on line 10.

Persons NOT sponsored in this affidavit:b. Yourself.

Part 6. Sponsor's income and employment.

22.I am currently:

e. If you have any other dependents, enter the number here.

c. If you are currently married, enter "1" for your spouse.

d. If you have dependent children, enter the number here.

Form I-864 (Rev. 10/18/07)Y Page 3

1

For Government

Use Only

23. My current individual annual income is: $

(Company Name)

(Date)

OPTIONAL: If you have siblings, parents, or adult children with

the same principal residence who are combining their income

with yours by submitting Form I-864A, enter the number here.

If you have sponsored any other persons on an I-864 or I-864 EZ

who are now lawful permanent residents, enter the number here.

f.

g.

Add together lines and enter the number here. Household Size:h.

(See Step-by-Step Instructions)

Employed as a/ana.

Name of Employer #1 (if applicable)

Name of Employer #2 (if applicable)

Self-employed as a/anb.

Retired fromc.

Unemployed sinced.

since

.

.

.

.

.

.


15/19

For GovernmentUse Only

c. Total Household Income: $

Form I-864 (Rev. 10/18/07)Y Page 4

Poverty line for year

_______________ is:

$

Household Size =

(Name)

(Total all lines from 24a and 24b. Will be Compared to Poverty Guidelines -- See Form I-864P.)

The persons listed above have completed Form I-864A. I am filing along with this

form all necessary Forms I-864A completed by these persons.

d.

The person listed above,e.

complete Form I-864A because he/she is the intending immigrant and has no

accompanying dependents.

Name

24. My current annual household income:

$

b.

$

a. List your income from line 23 of this form.

Income you are using from any other person who was counted in your householdsize, including, in certain conditions, the intending immigrant. (See step-by-stepinstructions.) Please indicate name, relationship and income.

$

$

$

25. Federal income tax return information.

I have filed a Federal tax return for each of the three most recent tax years. I have

attached the required photocopy or transcript of my Federal tax return for only the

most recent tax year.

(Optional) I have attached photocopies or transcripts of my Federal tax returns for my

second and third most recent tax years.

Tax Year

$(most recent)

My total income (adjusted gross income on IRS Form 1040EZ) as reported on my

Federal tax returns for the most recent three years was:

$(2nd most recent)

$(3rd most recent)

Total Income

does not need to

Relationship Current Income


16/19

Add together lines 28a, b, and c, and enter the numberhere.

For Government UseOnly

Form I-864 (Rev. 10/18/07)Y Page 5

Poverty line for year

_______________ is:

$

Household Size =

Enter the net cash value of real-estate holdings. (Net means

current assessed value minus mortgage debt.)

Part 7. Use of assets to supplement income. (Optional)

a.

If your income, or the total income for you and your household, from line 24c exceeds the

Federal Poverty Guidelines for your household size, YOU ARE NOT REQUIRED to

complete this Part. Skip to Part 8.

26. Your assets (Optional)

TOTAL:

$

$

$

b.

Add together lines 26 a, b and c and enter the

number here.

d.

28. Assets of the principal sponsored immigrant. (Optional)

Assets from Form I-864A, line 12d for

$

27. Your household member's assets from Form I-864A.(Optional)

The principal sponsored immigrant is the person listed in line 2.

Add together lines 26d, 27 and 28d and enter the

number here. TOTAL:

(Name of Relative)

$

$

$

$

$

Enter the current cash value of the sponsored immigrant's

stocks, bonds, certificates of deposit, and other assets not

included on line a or b.

Enter the net cash value of all the sponsored immigrant's real

estate holdings. (Net means investment value minus

mortgage debt.)

b.

c.

Enter the balance of the sponsored immigrant's savings and

checking accounts.

a.

d.

29. Total value of assets.

The total value of all

assests, line 29, must equal5 times (3 times for

spouses and children of

USCs, or 1 time for

orphans to be formally

adopted in the U.S.) the

difference between the

poverty guidelines and the

sponsor's household

income, line 24c.

Enter the net cash value of all stocks, bonds, certificates of

deposit, and any other assets not already included in lines 26

(a) or (b).

$c.

Enter the balance of all savings and checking accounts.


17/19

This provision does not apply to public benefits specified in section 403(c) of the Welfare Reform Act such as, but not

limited to, emergency Medicaid, short-term, non-cash emergency relief; services provided under the National SchoolLunch and Child Nutrition Acts; immunizations and testing and treatment for communicable diseases; and means-tested

programs under the Elementary and Secondary Education Act.

Form I-864 (Rev. 10/18/07)Y Page 6

Please note that, by signing this Form I-864, you agree to assume certain specific obligations under the Immigration and

Nationality Act and other Federal laws. The following paragraphs describe those obligations. Please read the following

information carefully before you sign the Form I-864. If you do not understand the obligations, you may wish to consult

an attorney or accredited representative.

Part 8. Sponsor's Contract.

If you sign a Form I-864 on behalf of any person (called the "intending immigrant") who is applying for an immigrant

visa or for adjustment of status to a permanent resident, and that intending immigrant submits the Form I-864 to the U.S.

Government with his or her application for an immigrant visa or adjustment of status, under section 213A of the

Immigration and Nationality Act these actions create a contract between you and the U. S. Government. The intending

immigrant's becoming a permanent resident is the "consideration" for the contract.

Under this contract, you agree that, in deciding whether the intending immigrant can establish that he or she is not

inadmissible to the United States as an alien likely to become a public charge, the U.S. Government can consider your

income and assets to be available for the support of the intending immigrant.

What is the Legal Effect of My Signing a Form I-864?

You cannot be made to sign a Form 1-864 if you do not want to do so. But if you do not sign the Form I-864, the

intending immigrant may not be able to become a permanent resident in the United States.

What If I choose Not to Sign a Form I-864?

If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed,

then until your obligations under the Form I-864 terminate, your income and assets may be considered ("deemed") to be

available to that person, in determining whether he or she is eligible for certain Federal means-tested public benefits and

also for State or local means-tested public benefits, if the State or local government's rules provide for consideration

("deeming) of your income and assets as available to the person.

What Does Signing the Form I-864 Require Me to do?

If an intending immigrant becomes a permanent resident in the United States based on a Form I-864 that you have signed,

then, until your obligations under the Form I-864 terminate, you must:

-- Provide the intending immigrant any support necessary to maintain him or her at an income that is at least 125 percent

of the Federal Poverty Guidelines for his or her household size (100 percent if you are the petitioning sponsor and are

on active duty in the U.S. Armed Forces and the person is your husband, wife, unmarried child under 21 years old.)

-- Notify USCIS of any change in your address, within 30 days of the change, by filing Form I-865.

What Other Consequences Are There?

Contract continued on following page.


18/19

All the factual statements in this affidavit of support are true and correct.

No longer has lawful permanent resident status, and has departed the United States;

Form I-864 (Rev. 10/18/07)Y Page 7

If you are sued, and the court enters a judgment against you, the person or agency that sued you may use any legally

permitted procedures for enforcing or collecting the judgment. You may also be required to pay the costs of collection,

including attorney fees.

If a Federal, State or local agency, or a private agency provides any covered means-tested public benefit to the person whobecomes a permanent resident based on the Form I-864 that you signed, the agency may ask you to reimburse them for the

amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that

the agency believes you owe.

If you do not file a properly completed Form I-865 within 30 days of any change of address, USCIS may impose a civil

fine for your failing to do so.

Becomes a U.S. citizen;

When Will These Obligations End?

Has worked, or can be credited with, 40 quarters of coverage under the Social Security Act;

Your obligations under a Form I-864 will end if the person who becomes a permanent resident based on a Form I-864 that

you signed:

Becomes subject to removal, but applies for and obtains in removal proceedings a new grant of adjustment of status,

based on a new affidavit of support, if one is required; or

Dies.

Note that divorce does not terminate your obligations under this Form I-864.

If you do not provide sufficient support to the person who becomes a permanent resident based on the Form I-864 that you

signed, that person may sue you for this support.

What If I Do Not Fulfill My Obligations?

(Print Sponsor's Name)

I know the contents of this affidavit of support that I signed.

I,30.

certify under penalty of perjury under the laws of the United States that:

a.

b.

Your obligations under a Form I-864 also end if you die. Therefore, if you die, your Estate will not be required to take

responsibility for the person's support after your death. Your Estate may, however, be responsible for any support that

you owed before you died.

I have read and I understand each of the obligations described in Part 8, and I agree, freely and without any

mental reservation or purpose of evasion, to accept each of those obligations in order to make it possible for the

immigrants indicated in Part 3 to become permanent residents of the United States;

I agree to submit to the personal jurisdiction of any Federal or State court that has subject matter jurisdiction of a

lawsuit against me to enforce my obligations under this Form I-864;

c.

d.

Each of the Federal income tax returns submitted in support of this affidavit are true copies, or are unaltered tax

transcripts, of the tax returns I filed with the U.S. Internal Revenue Service; ande.

Sign on following page.

,


19/19

I authorize the Social Security Administration to release information about me in its records to the Department of

State and U.S. Citizenship and Immigration Services.

Form I 864 (Rev 10/18/07)Y Page 8

(Sponsor's Signature) (Date-- mm/dd/yyyy)

31.

f.

Any and all other evidence submitted is true and correct.g.

Telephone Number:

Part 9. Information on Preparer, if prepared by someone other than the sponsor.

I certify under penalty of perjury under the laws of the United States that I prepared this affidavit of support at

the sponsor's request and that this affidavit of support is based on all information of which I have knowledge.

Signature:

Printed Name:

Firm Name:

Address:

Date:

Business State ID # (if any)

(mm/dd/yyyy)

E-Mail Address:

Documents

I-864affidvit of Support